A 36 year old G3P3003 is seeking info regarding contraception. She smokes 1/2 pack per day,
is allergic to latex, weights 212lbs, and is unsure about future pregnancies. Which of the
following would be the best choice for this patient? - ANSWER IUD
A 19 year old presents to the ED with acute abdominal pain & pelvic pain. She is febrile &
nauseated. Exam reveals lower abdominal pain & pelvic tenderness as well as moderate
cervical motion tenderness. What is the best next step? - ANSWER Hospitalization & IV
antibiotics
A new mother presents for evaluation of her right breast. She has been breastfeeding
successfully for 6 weeks. The baby is growing & satisfied. She has a low grade fever and the
lateral right breast is red and warm. What is the most likely pathogen? - ANSWER S.
aureus
A 32 year old G0P0 presents for infertility workup. She and her partner have been trying
unsuccessfully to get pregnant for 2 years. Menses are irregular, coming every 3-6 weeks;
she has no history of abnormal pap or pelvic examination. She is overweight and states her
weight has always been a problem despite diet and exercise. Her PCP has warned her that
she is pre diabetic and has high lipid levels. What is the expected result of a pelvic US? -
ANSWER String of pearls appearance in ovaries
A pap smear of a 23 year old female returns as CIN-1; HPV+. What is the recommended
follow up? - ANSWER Repeat pap in 6 months
Pelvic exam of a 23 year old female reveals an ovarian mass. US confirms a 2cm x 2cm simple
fluid filled cyst. What is the recommended next step? - ANSWER Monitor over the next 1-
2 cycles then reassess
1
,A 29 year old presents for workup of extremely painful menses which often require absence
from work. She denies dyspareunia, dyschezia, or intermittent bleeding. On exam, she is
tender to palpation of the right cul-de-sac. What is the recommended management at this
time? - ANSWER Give a trial of OCPs for symptomatic relief
A 33 year old G3P2102 complains of pressure or fullness in the pelvis. Menses remain
regular, although she has had a few episodes of inter menstrual bleeding in the past year.
LMP was 3 weeks ago. Exam reveals an enlarged, irregular uterine mass. What is the most
likely diagnosis? - ANSWER Leiomyoma
A 17 year old complains of painful lower pelvic cramping and breast tenderness with
menses. She has one sexual partner and uses condoms for contraception. She denies vaginal
discharge, abnormal bleeding, and dyspareunia. Pelvic exam is normal. What is the
recommended management? - ANSWER NSAID, begin 2-3 days before menses and
continue through the cycle
A 27 year old female describes symptoms of irritability, insomnia, bloating, depression, and
fatigue that begin each month about 1 wk prior to her menses and abate within 2 days of
menses. She denies a history of mental health problems, vaginal discharge, or dyspareunia.
Pelvic exam is normal. Which of the following lifestyle changes is most likely to alleviate her
symptoms? - ANSWER Reduce caffeine
A 32 year old presents for evaluation of sore breasts. Exam reveals multiple tender lesions.
Further questioning confirms that the breast fluctuates in size with tenderness through her
menses cycles. What lifestyle intervention will most likely relieve her discomfort? -
ANSWER Wear a supportive bra
A 26 year old is concerned because she had unprotected sex 2 days ago. She decides to take
synthetic progestin pills as directed to prevent pregnancy. What is the most common side
effect for which she should be warned? - ANSWER Nausea and vomiting
A 26 year old who is 8 weeks pregnant presents with vaginal bleeding. Speculum exam
reveals an open cervix without any visible products of conception. What is the most likely
diagnosis? - ANSWER Complete abortion
2
,A 27 year old at 9 weeks gestation presents with vaginal bleeding. Exam reveals a 20 week
sized uterus. B-hCG levels are exceptionally high. US reveals a mass with snowstorm
appearance. What is the recommended treatment? - ANSWER Suction curettage
A 23 year old at 33 weeks gestation presents with painful contractions and watery discharge.
Cervix is 3cm dilated and 80% effaced. Fetal HR is 160 and regular. BP is 140/88. Urine is
positive for blood. What is the diagnosis? - ANSWER Preterm labor
A 26 year old pregnant female with normal BMI presents for prenatal care. She is unsure of
her last menses. The top of her uterus is felt about 2cm below the umbilicus. What is the
best estimate of gestational age? - ANSWER 16 weeks
A 29 year old at 24 weeks gestation has an elevated glucose of 152 after a 50g challenge.
The 3 hour glucose tolerance test reveals fasting 92g, 1 hour 201g, 2 hour 180g, 3 hour 138g.
What is the best diagnosis? - ANSWER Gestational diabetes
A 25 year old female presents with right side lower abdominal pain and spotting. LMP was 6
weeks ago. What diagnostic study is warranted at this time? - ANSWER TVUS
A 33 year old G1P0 at 37 weeks presents with headache and blurred vision. She has a BP of
166/112, urine is positive for protein 4+. She is admitted and started on Mg sulfate and
labetalol. 2 hours later she complains of difficulty breathing. BP is 148/98, HR 100, RR 26,
DTR are slow. What is the recommended management at this time? - ANSWER Ca
gluconate
A 24 year old G1P0 undergoes NST at 36 weeks. Tracing shows accelerations of fetal HR of
10-12bpm from baseline lasting 15 seconds; there are no decelerations. What is the
recommended management? - ANSWER Reassure mother results are normal
3
, A 29 year old G1P0 presents for initial prenatal care. LMP was 8 weeks ago. Mother is B- and
father is A+. Which of the following is recommended to include in her prenatal care? -
ANSWER Administer RhoGam at 28 to 29 weeks and again after delivery
A 41 year old overweight female is 9 weeks pregnant. BP is 160/114; repeat after 5 minutes
of rest results in a BP of 162/110. What is the treatment of choice? - ANSWER
methyldopa
A 32 year old G3P2 is in labor. Baby is moving and has a HR of 170. Monitor shows
decelerations of fetal HR that begin at the peak of contractions. There are no accelerations.
What is the best interpretation? - ANSWER Perform US to assess placenta
A 31 year old at 34 weeks presents with painless vaginal bleeding. Vital signs are stable.
Baby is moving, and HR is 166. What is the diagnosis? - ANSWER placenta previa
A 43 year old female presents complaining of palpitations and jitteriness. She quickly tires
doing routine tasks. Exam is noncontributory. Labs reveal a mildly low hemoglobin &
hematocrit with normal RBC indices. TSH is low and T4 is markedly elevated. What is the
most likely diagnosis? - ANSWER Graves disease
A 33 year old patient presents with weight gain, easy bruising, and proximal muscle
weakness. Exam reveals excess adipose tissue in the face and upper back, violaceous striae,
and purpura. What is the expected result of an overnight dexamethasone suppression test? -
ANSWER Morning cortisol level elevated
A 38 year old asymptomatic female has a 1cm rounded, non-tender thyroid nodule. T3, T4,
& TSH are within normal limits. US confirms a single, heterogenous lesion. What is the next
best step? - ANSWER FNA
A 48 year old male presents with flank pain radiating to the groin. Urine is positive for blood.
He is admitted and started on IVF and given analgesics. Admission labs reveal elevated
calcium & low phosphorous. Upon further questioning, he admits to fatigue, weakness,
4
is allergic to latex, weights 212lbs, and is unsure about future pregnancies. Which of the
following would be the best choice for this patient? - ANSWER IUD
A 19 year old presents to the ED with acute abdominal pain & pelvic pain. She is febrile &
nauseated. Exam reveals lower abdominal pain & pelvic tenderness as well as moderate
cervical motion tenderness. What is the best next step? - ANSWER Hospitalization & IV
antibiotics
A new mother presents for evaluation of her right breast. She has been breastfeeding
successfully for 6 weeks. The baby is growing & satisfied. She has a low grade fever and the
lateral right breast is red and warm. What is the most likely pathogen? - ANSWER S.
aureus
A 32 year old G0P0 presents for infertility workup. She and her partner have been trying
unsuccessfully to get pregnant for 2 years. Menses are irregular, coming every 3-6 weeks;
she has no history of abnormal pap or pelvic examination. She is overweight and states her
weight has always been a problem despite diet and exercise. Her PCP has warned her that
she is pre diabetic and has high lipid levels. What is the expected result of a pelvic US? -
ANSWER String of pearls appearance in ovaries
A pap smear of a 23 year old female returns as CIN-1; HPV+. What is the recommended
follow up? - ANSWER Repeat pap in 6 months
Pelvic exam of a 23 year old female reveals an ovarian mass. US confirms a 2cm x 2cm simple
fluid filled cyst. What is the recommended next step? - ANSWER Monitor over the next 1-
2 cycles then reassess
1
,A 29 year old presents for workup of extremely painful menses which often require absence
from work. She denies dyspareunia, dyschezia, or intermittent bleeding. On exam, she is
tender to palpation of the right cul-de-sac. What is the recommended management at this
time? - ANSWER Give a trial of OCPs for symptomatic relief
A 33 year old G3P2102 complains of pressure or fullness in the pelvis. Menses remain
regular, although she has had a few episodes of inter menstrual bleeding in the past year.
LMP was 3 weeks ago. Exam reveals an enlarged, irregular uterine mass. What is the most
likely diagnosis? - ANSWER Leiomyoma
A 17 year old complains of painful lower pelvic cramping and breast tenderness with
menses. She has one sexual partner and uses condoms for contraception. She denies vaginal
discharge, abnormal bleeding, and dyspareunia. Pelvic exam is normal. What is the
recommended management? - ANSWER NSAID, begin 2-3 days before menses and
continue through the cycle
A 27 year old female describes symptoms of irritability, insomnia, bloating, depression, and
fatigue that begin each month about 1 wk prior to her menses and abate within 2 days of
menses. She denies a history of mental health problems, vaginal discharge, or dyspareunia.
Pelvic exam is normal. Which of the following lifestyle changes is most likely to alleviate her
symptoms? - ANSWER Reduce caffeine
A 32 year old presents for evaluation of sore breasts. Exam reveals multiple tender lesions.
Further questioning confirms that the breast fluctuates in size with tenderness through her
menses cycles. What lifestyle intervention will most likely relieve her discomfort? -
ANSWER Wear a supportive bra
A 26 year old is concerned because she had unprotected sex 2 days ago. She decides to take
synthetic progestin pills as directed to prevent pregnancy. What is the most common side
effect for which she should be warned? - ANSWER Nausea and vomiting
A 26 year old who is 8 weeks pregnant presents with vaginal bleeding. Speculum exam
reveals an open cervix without any visible products of conception. What is the most likely
diagnosis? - ANSWER Complete abortion
2
,A 27 year old at 9 weeks gestation presents with vaginal bleeding. Exam reveals a 20 week
sized uterus. B-hCG levels are exceptionally high. US reveals a mass with snowstorm
appearance. What is the recommended treatment? - ANSWER Suction curettage
A 23 year old at 33 weeks gestation presents with painful contractions and watery discharge.
Cervix is 3cm dilated and 80% effaced. Fetal HR is 160 and regular. BP is 140/88. Urine is
positive for blood. What is the diagnosis? - ANSWER Preterm labor
A 26 year old pregnant female with normal BMI presents for prenatal care. She is unsure of
her last menses. The top of her uterus is felt about 2cm below the umbilicus. What is the
best estimate of gestational age? - ANSWER 16 weeks
A 29 year old at 24 weeks gestation has an elevated glucose of 152 after a 50g challenge.
The 3 hour glucose tolerance test reveals fasting 92g, 1 hour 201g, 2 hour 180g, 3 hour 138g.
What is the best diagnosis? - ANSWER Gestational diabetes
A 25 year old female presents with right side lower abdominal pain and spotting. LMP was 6
weeks ago. What diagnostic study is warranted at this time? - ANSWER TVUS
A 33 year old G1P0 at 37 weeks presents with headache and blurred vision. She has a BP of
166/112, urine is positive for protein 4+. She is admitted and started on Mg sulfate and
labetalol. 2 hours later she complains of difficulty breathing. BP is 148/98, HR 100, RR 26,
DTR are slow. What is the recommended management at this time? - ANSWER Ca
gluconate
A 24 year old G1P0 undergoes NST at 36 weeks. Tracing shows accelerations of fetal HR of
10-12bpm from baseline lasting 15 seconds; there are no decelerations. What is the
recommended management? - ANSWER Reassure mother results are normal
3
, A 29 year old G1P0 presents for initial prenatal care. LMP was 8 weeks ago. Mother is B- and
father is A+. Which of the following is recommended to include in her prenatal care? -
ANSWER Administer RhoGam at 28 to 29 weeks and again after delivery
A 41 year old overweight female is 9 weeks pregnant. BP is 160/114; repeat after 5 minutes
of rest results in a BP of 162/110. What is the treatment of choice? - ANSWER
methyldopa
A 32 year old G3P2 is in labor. Baby is moving and has a HR of 170. Monitor shows
decelerations of fetal HR that begin at the peak of contractions. There are no accelerations.
What is the best interpretation? - ANSWER Perform US to assess placenta
A 31 year old at 34 weeks presents with painless vaginal bleeding. Vital signs are stable.
Baby is moving, and HR is 166. What is the diagnosis? - ANSWER placenta previa
A 43 year old female presents complaining of palpitations and jitteriness. She quickly tires
doing routine tasks. Exam is noncontributory. Labs reveal a mildly low hemoglobin &
hematocrit with normal RBC indices. TSH is low and T4 is markedly elevated. What is the
most likely diagnosis? - ANSWER Graves disease
A 33 year old patient presents with weight gain, easy bruising, and proximal muscle
weakness. Exam reveals excess adipose tissue in the face and upper back, violaceous striae,
and purpura. What is the expected result of an overnight dexamethasone suppression test? -
ANSWER Morning cortisol level elevated
A 38 year old asymptomatic female has a 1cm rounded, non-tender thyroid nodule. T3, T4,
& TSH are within normal limits. US confirms a single, heterogenous lesion. What is the next
best step? - ANSWER FNA
A 48 year old male presents with flank pain radiating to the groin. Urine is positive for blood.
He is admitted and started on IVF and given analgesics. Admission labs reveal elevated
calcium & low phosphorous. Upon further questioning, he admits to fatigue, weakness,
4
